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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, S25 <br />220 HIGH STREET,NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588.~147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am a reglsteced builder OR ( the ,~uthorizOd representative <br /> <br />~IGNATURE OF APPLICANT; .............. <br /> OATE; ......... <br /> <br />DATE: 05/25/9~ <br /> <br /> ~r' 47 H ST <br /> <br />TIME~ 9:~6:32 <br /> <br />' ' r~,x O:ffl ......... cA¥~o.',': <br /> ~o~e~_e~!tf¢~: ........................... 0R~NTIAL <br /> <br />....... 0R-.--?i~;4~2 ................ DETRO'IT '- ~- 'NO ..... <br /> <br />MAILING ^O{~t:lE~:- ' SUBD[VISfON: <br /> <br />1B~4 PEPPERTREE <br />SALEN OR 97396 <br /> <br /> PATTON A~)I)IT I ON <br /> <br /> SITE NUMBqER: ?~-01578 <br />........... ...... <br /> <br />195 <br /> <br />TYPE: ON-SITE <br /> <br />PERMIT OR APPLICATION <br /> <br />COIITRAC fOR. <br />STANLEY, STEVE <br />t, 8e4 PEPPERTREE CT <br />BALEM OR 97366 <br />PHONE~ 378-1~2 <br /> <br />41421 <br /> <br />WATER SUPPLY: CW <br />TEST HO'LES READY: <br />~ITE EVALUATION NUMBER: 41131 <br />EXISTING TANK 8IZE: <br />BXiSTiNG ~AIN PIELD LINES: <br />SEPTIC TANK PUMPEI>: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUN'! <br /> STANDARD ON-SITE SYSTEM 1 $21. g.90 <br /> <br /> TOTAL ASSESSED FEEB $210.80 <br /> PREVIOUS RECEIP'f8 $210.90 <br /> TNiS RECEIPT <br /> <br /> BALANCE DUE $0.09 <br /> PAYEE: IN¥OICE NO: <br /> RECEIVED BY: CL 'I'YPE~ CHECK $: <br /> <br /> SEE ATTACHED I)OCUN~NT FO~ REQUIREMENTS OF ON-S~TE SEWAGE SYSTE~ <br /> <br /> · THIS IS A VALI9 PERMIT ~ THIS PERMIT EXPIRES 368 DAYS FROM IT~ ISSUE DATE. IF <br />CONSTRUCTION FAILS TO MEET ALt. REQUIREMENT~ OF STATE LAWS AND NARION COUNTY BUIL~ING AND <br />ZONING ORDINANCES~ TN~S PERN~T SHALL BECOME NULL ANB VOID, <br /> <br />REMARKS: STD .,STEM <br /> <br />DONALD E. WOODLEY~ MARION COUNTY BUILDING OFFICIAL./ BY .......................................... <br /> <br />OFFICECOPY <br /> <br /> <br />